LETTER TO THE EDITOR
Angiotensin-converting enzyme polymorphism (I/D) and coronary heart disease in young adults: Reply
Vicky A. Cameron, PhD
Christchurch Cardioendocrine Research Group, Christchurch School of Medicine and Health Sciences, P.O. Box 4345, Christchurch 8001, New Zealand
Barry R. Palmer, PhD
vicky.cameron{at}chmeds.ac.nz
We read with interest the letter from Martin Fernandez et al. regarding our study of the angiotensin-converting enzyme (ACE) I/D polymorphism and mortality after myocardial infarction (MI). We agree that the role of the ACE I/D polymorphism in predicting mortality after acute MI is still controversial. However, it is difficult to draw comparisons between our own study (1) and that described by Martin Fernandez et al. Their study claimed to show no relationship between ACE genotype and clinical outcome. This is hardly surprising in a study of 163 MI patients, of which only three died. In addition, this cohort differed greatly from ours in being <50 years old, and all subjects were male. Our study cohort consisted of 978 MI patients with a mean age of 62.1 years, of which 78% were male. In addition, it is well known that genotype frequencies differ between populations with different ethnicities. The allele frequencies for the ACE I/D polymorphism reported in the cases by Martin Fernandez et al. (DD 44%, I/D 36%, II 20%) are very different from most other studies of European populations (2), including ours (DD 27.3%; I/D 49.5%; II 23.2%). Therefore, it is difficult to draw comparisons between such very different patient groups.
Finally, our study reported not just an association between genotype and mortality, but it also examined the interaction between ACE genotype and established post-infarct prognostic markers (aminoterminal brain natriuretic peptide, N-BNP, and left ventricular ejection fraction) to identify patients at high risk. We believe that combining genetic data with other markers of disease severity in this way provides superior prognostic information.
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References
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1. Palmer BR, Pilbrow AP, Yandle TG, et al. Angiotensin-converting enzyme gene polymorphism interacts with left ventricular ejection fraction and brain natriuretic peptide levels to predict mortality after myocardial infarction. J Am Coll Cardiol. 2003;41:729–736[Abstract/Free Full Text]
2. Samani NJ, Thompson JR, O'Toole L, Channer K, Woods KL. A meta-analysis of the association of the deletion allele of the angiotensin-converting enzyme gene with myocardial infarction. Circulation. 1996;94:708–712[Abstract/Free Full Text]
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